Provider Demographics
NPI:1154619435
Name:FOUNTAIN, KRISTIE N (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:N
Last Name:FOUNTAIN
Suffix:
Gender:
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 PINE RUN
Mailing Address - Street 2:
Mailing Address - City:TEGA CAY
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8328
Mailing Address - Country:US
Mailing Address - Phone:434-665-7214
Mailing Address - Fax:
Practice Address - Street 1:2848 PLEASANT RD
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-9490
Practice Address - Country:US
Practice Address - Phone:800-779-4089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7235235Z00000X
VA2202006048235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist